• By completing this enrollment form, you are choosing to receive your Hanover County Utility Billing Statement
electronically. You will no longer receive a printed statement via US Mail.

• You have the right to withdraw your consent at any time by contacting Customer Service at (804) 365-6024.

• Hanover County Department of Public Utilities will email your statement to the address you provide. If you fail to
receive it, you are still responsible for all charges on your account by the due date. If payment is received after the
due date, penalties will apply.

• All final bills, past due and delinquent notifications will be delivered to your mailing address via US Mail.

• Failure to receive your e-bill does not waive late fees/penalties.

• You are responsible for notifying Hanover County Department of Public Utilities of any changes to your email
address.

• You can also view your Hanover County Utility Bill online at the County website at www.hanovercounty.gov.

I have read and understand the terms & conditions of electronic E-notifications from Hanover County Department of
Public Utilities, and by signing below I authorize Hanover County Department of Public Utilities to send utility bills for
this account to the email address provided.

Electronic Signature Agreement

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.